Ultrasound- and Fluoroscopy-Guided Curved Needle Lumbar Sympathetic Radiofrequency Ablation for Diabetic Peripheral Neuropathy Pain: A Randomized Trial.

BACKGROUND

Lumbar sympathetic ganglion radiofrequency ablation (LSGRF) is an effective pain relief technique for patients with diabetic peripheral neuropathic pain (DPNP). Fluoroscopy, when combined with ultrasound, can guide the needle tip to locate the lumbar sympathetic ganglion (LSG) accurately, but the vertebrae pose an obstruction.

OBJECTIVES

The purpose of this study is to compare the technical efficacy and clinical outcomes between curved-needle and straight-needle techniques for LSGRF in DPNP patients.

STUDY

DESIGN

A prospective, randomized design.

SETTING

The study was carried out in the anesthesiology department of Foshan Fosun Chancheng Hospital, Foshan, China.

METHODS

This study included 60 DPNP patients aged 18 to 80 years, with ASA grade II to III and BMI 18 to 30 kg/m2, who underwent combinations of LSGRF and anhydrous ethanol under ultrasound and fluoroscopy guidance. The patients were divided randomly into the curved-needle group (Group C, n = 30) and the straight-needle group (Group S, n = 30). The primary endpoint was the duration of the procedure. Secondary outcomes included ablation success rate, fluoroscopic imaging time, number of needle redirections, frequency of needle-bone contacts, serial pain scores on the visual analog scale (VAS), and surgical complications.

RESULTS

Group C demonstrated statistically significant advantages in procedural efficiency, including shorter operation time (10.6 ± 3.1 min vs. 15.2 ± 2.3 min, P < 0.001), fewer needle redirections (0.5 vs. 4.5, P < 0.001), and reduced bone contacts (1.0 vs. 4.0, P < 0.001), over Group S. While the ablation success rate was numerically higher in Group C (96.7% vs 90.0%), this difference did not reach statistical significance (P = 0.611). Both groups showed a significant reduction in VAS scores from their preoperative counterparts at all postoperative assessment time points (P < 0.05), but there was no significant difference in VAS scores between the groups. The complication rate was lower in Group C (3.33% vs. 13.33%, P = 0.357), but that result had no statistical significance.

LIMITATIONS: The analgesic effect of LSGRF and the temperature of the affected limb were evaluated based only on short-term outcomes.

CONCLUSIONS

Compared to the traditional straight needle, the curved needle can reduce the operation time and the number of needle redirections in LSGRF for treating DPNP. Satisfaction of both patients and anesthesiologists also increased when using the curved needle. However, no statistically significant differences were observed between the 2 types of needles in terms of success rate or post-procedural analgesic efficacy.